NPI | 1891234050 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: AL 46766) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60853764) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-02-20 |
Last Update Date | 2024-01-15 |