| NPI | 1245734508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2020011311) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 61581) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2024-03-26 |