NPI | 1861700932 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 122300000X Dentist (Licence: PA dx038451) |
Enumeration Date | 2010-09-22 |
Last Update Date | 2011-06-03 |