| NPI | 1710670922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN28287) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 28287) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2023-07-07 |