NPI | 1164743969 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: HI 2690) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 25528) |
1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60642474) | |
390200000X Student in an Organized Health Care Education/Training Program | |
122300000X Dentist (Licence: TX 25528) | |
Enumeration Date | 2010-06-15 |
Last Update Date | 2017-09-11 |