NPI | 1205584802 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.027178) |
Enumeration Date | 2022-03-13 |
Last Update Date | 2023-05-25 |