NPI | 1588082002 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NH 04147) |
Additional Taxonomies | 122300000X Dentist (Licence: MA 0000000000) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2014-04-01 |
Last Update Date | 2021-05-21 |