NPI | 1477043198 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 060879) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 11473) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-05-17 |
Last Update Date | 2024-07-03 |