NPI | 1477075125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416462) |
Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001753) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-07-14 |
Last Update Date | 2022-01-17 |