NPI | 1316458797 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CO 00205952) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
103K00000X Behavior Analyst | |
Enumeration Date | 2017-10-12 |
Last Update Date | 2024-07-03 |