NPI | 1124521828 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS042651) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS042651) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-03-09 |
Last Update Date | 2020-08-13 |