| NPI | 1386803963 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN DS0000009066) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 2700) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 14735) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2015-05-19 |