NPI | 1295583268 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NY 064696) |
Additional Taxonomies | 122300000X Dentist (Licence: OH RES.004818) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2024-05-07 |
Last Update Date | 2025-08-07 |