| NPI | 1780433995 |
|---|---|
| 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: LA 7608) |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-08-19 |