NPI | 1851943674 |
---|---|
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: OH 30.026852) |
122300000X Dentist (Licence: MN D13889) | |
122300000X Dentist (Licence: MI 2901601710) | |
Enumeration Date | 2019-07-11 |
Last Update Date | 2023-08-16 |