NPI | 1558744912 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN122827) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600896) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2015-07-02 |
Last Update Date | 2022-08-02 |