NPI | 1619479763 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MI 4587098112) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2018-03-05 |
Last Update Date | 2019-04-18 |