| NPI | 1922414457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN24271) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223G0001X Dentist, General Practice (Licence: FL DN24271) | |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2023-05-16 |