| NPI | 1548003114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DN29020) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN29020) |
| Enumeration Date | 2024-06-13 |
| Last Update Date | 2025-06-30 |