| NPI | 1972033751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN22586) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DN22586) |
| 122300000X Dentist (Licence: FL Dn22586) | |
| 1223G0001X Dentist, General Practice (Licence: FL DN22586) | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2020-05-06 |