NPI | 1194042945 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN19131) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2011010371) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2010-05-03 |
Last Update Date | 2016-04-12 |