| NPI | 1194385161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 16775) |
| 1223G0001X Dentist, General Practice (Licence: FL DN23969) | |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2021-07-06 |