NPI | 1528593241 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: AZ D011248) |
Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA DDS104965) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-05-01 |
Last Update Date | 2022-01-25 |