| NPI | 1568106052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 063189) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN27719) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2023-07-27 |