NPI | 1184278822 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 108872) |
Additional Taxonomies | 122300000X Dentist (Licence: NC 151259) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-07-31 |
Last Update Date | 2023-07-25 |