NPI | 1306581400 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40005) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX ETN926) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-05-03 |
Last Update Date | 2024-07-05 |