| 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 |