| NPI | 1992495238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN30762) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH RES.004590) |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2025-07-15 |