NPI | 1306634019 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN30637) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN30637) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2025-04-30 |
Last Update Date | 2025-07-06 |