NPI | 1609551100 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DN28943) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN28943) |
Enumeration Date | 2023-06-21 |
Last Update Date | 2025-05-20 |