NPI | 1427680669 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 122300000X Dentist (Licence: NY 061767) |
Enumeration Date | 2020-02-05 |
Last Update Date | 2021-07-20 |