| NPI | 1255439840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN013700) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2008-08-14 |