| NPI | 1821830696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2951001002) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12014439A) |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2025-06-25 |