NPI | 1124471941 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA Ds042670) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA ds042670) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-07-16 |
Last Update Date | 2020-10-05 |