| NPI | 1437783792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL 25419) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 123456789) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2025-04-07 |