NPI | 1851710644 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 122300000X Dentist (Licence: LA 6577) |
Enumeration Date | 2014-04-09 |
Last Update Date | 2015-06-04 |