| NPI | 1992017164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN 19032) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DN 19032) |
| Enumeration Date | 2010-07-05 |
| Last Update Date | 2013-01-10 |