| NPI | 1649585480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN21949) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN21949) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2017-10-06 |