| NPI | 1831695410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN23532) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223P0300X Dentist, Periodontics (Licence: FL DN23532) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2021-05-21 |