NPI | 1780224915 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 12873) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 39450) |
Enumeration Date | 2020-01-15 |
Last Update Date | 2024-01-16 |