| NPI | 1467805390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2016021053) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2016021053) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IA DDS-09871) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30487) | |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2021-04-01 |