NPI | 1346730702 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 39262) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 16781) |
390200000X Student in an Organized Health Care Education/Training Program | |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 061019) | |
Enumeration Date | 2018-05-11 |
Last Update Date | 2024-06-18 |