| NPI | 1477075489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN22890) |
| 122300000X Dentist (Licence: OH 30.025761) | |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2020-06-14 |