NPI | 1649962937 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2951000936) |
Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
Enumeration Date | 2023-05-24 |
Last Update Date | 2024-06-21 |