NPI | 1285219394 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MO 2022005005) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
122300000X Dentist (Licence: AZ D011145) | |
Enumeration Date | 2021-03-10 |
Last Update Date | 2024-03-31 |