NPI | 1629715560 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 1859374) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 04743) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-05-12 |
Last Update Date | 2022-10-25 |