NPI | 1932448602 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WY 1369) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30368) |
Enumeration Date | 2013-01-31 |
Last Update Date | 2014-07-28 |