NPI | 1174973218 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1857271) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA DN1857271) |
Enumeration Date | 2016-06-20 |
Last Update Date | 2020-08-04 |