| NPI | 1508350992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DRPM3072) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 00203646) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2026-09-13 |