| NPI | 1295274835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN23069) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN23069) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2022-09-13 |