| NPI | 1871916825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN28630) |
| 122300000X Dentist (Licence: PA DS044029) | |
| 125Q00000X Oral Medicine (Licence: PA DS044029) | |
| 125Q00000X Oral Medicine (Licence: FL DN28630) | |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2024-01-09 |