NPI | 1124645452 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 122300000X Dentist (Licence: CA DDS107021) |
Enumeration Date | 2020-07-02 |
Last Update Date | 2023-09-26 |