NPI | 1417335258 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 220) |
Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OK 6693) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30446) | |
Enumeration Date | 2015-05-13 |
Last Update Date | 2017-11-15 |