| NPI | 1154851145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 7754) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL 24708) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2026-01-09 |