| NPI | 1982593083 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN30607) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DN30607) |
| Enumeration Date | 2025-07-02 |
| Last Update Date | 2026-04-27 |