NPI | 1396306759 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS042462) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS042462) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-06-26 |
Last Update Date | 2024-01-04 |