NPI | 1558986794 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 37744) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 37744) |
Enumeration Date | 2020-06-13 |
Last Update Date | 2023-08-07 |