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 |