| NPI | 1760178537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D011199) |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2024-07-22 |