NPI | 1245830736 |
---|---|
Other Name | RYAN ANDREW JOHNSON |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA DDS105999) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2020-10-26 |
Last Update Date | 2024-09-12 |