| NPI | 1114873429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DRPM3006) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 3006) |
| Enumeration Date | 2026-03-09 |
| Last Update Date | 2026-09-11 |