| NPI | 1992034086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM TD-00-128) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 53882) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2020-06-29 |