NPI | 1760053540 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2951000972) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-5291) |
Enumeration Date | 2021-07-02 |
Last Update Date | 2024-07-02 |