| NPI | 1902535495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ D011416) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D011416) |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2025-05-12 |