NPI | 1629644000 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 122300000X Dentist (Licence: NY 06251601) |
Enumeration Date | 2021-05-27 |
Last Update Date | 2024-01-14 |