NPI | 1922745454 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN10000621) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
390200000X Student in an Organized Health Care Education/Training Program (Licence: TX ETN956) | |
Enumeration Date | 2022-05-16 |
Last Update Date | 2024-11-24 |