NPI | 1457505869 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: NC 9186) |
Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: CA 58926) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2008-11-12 |
Last Update Date | 2018-02-06 |