| NPI | 1588397616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DRPM2664) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: FL DRPM2517) |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2025-07-16 |