| NPI | 1922893593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH RES.004874) |
| Additional Taxonomies | 1223D0001X Dentist Dental Public Health (Licence: OH RES.004874) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-04-14 |
| Last Update Date | 2025-06-24 |