NPI | 1467896571 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TX 29747) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
122300000X Dentist (Licence: WI 7125-15) | |
Enumeration Date | 2013-04-18 |
Last Update Date | 2015-09-26 |