| NPI | 1295182954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS040786) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA DS040786) |
| 122300000X Dentist (Licence: PA DS040786) | |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2022-07-06 |