| NPI | 1982223491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS045309) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204710) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI03077800) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2951000925) | |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2025-07-28 |