| NPI | 1942649900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 20483) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL DN20483) | |
| Enumeration Date | 2013-06-22 |
| Last Update Date | 2021-04-27 |