| NPI | 1548575970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN24590) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 14552) |
| 1223E0200X Dentist, Endodontics (Licence: NY 058318) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD 14552) | |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2020-07-03 |