NPI | 1003496316 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD5469) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM TD-00-137) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-04-11 |
Last Update Date | 2022-05-11 |