NPI | 1649971110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 39867) |
Enumeration Date | 2023-03-13 |
Last Update Date | 2023-10-03 |