NPI | 1073247730 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.027981) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS044045) |
122300000X Dentist (Licence: OH 30.027981) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-07-10 |
Last Update Date | 2025-07-10 |