NPI | 1487932547 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015150) |
Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855931) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2011-07-23 |
Last Update Date | 2022-04-17 |