| NPI | 1588353510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN29751) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D011900) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2024-12-13 |