NPI | 1851850705 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11084) |
Additional Taxonomies | 122300000X Dentist (Licence: OR D11084) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-03-19 |
Last Update Date | 2023-08-21 |