NPI | 1184088296 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00203912) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS041851) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-04-06 |
Last Update Date | 2023-03-15 |