NPI | 1255198081 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NV 8039) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
122300000X Dentist (Licence: OH 30.027470) | |
Enumeration Date | 2024-02-28 |
Last Update Date | 2024-07-17 |