NPI | 1851976096 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV LL-556-21) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 108923) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-03-09 |
Last Update Date | 2023-07-19 |