| NPI | 1457048167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 04943) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL DH27144) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-21 |
| Last Update Date | 2024-02-22 |