| NPI | 1851943674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026852) |
| 122300000X Dentist (Licence: MN D13889) | |
| 122300000X Dentist (Licence: MI 2901601710) | |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2023-08-16 |