| NPI | 1245736610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID 019.033573) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 36119) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 36119) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2022-05-13 |