| NPI | 1467947572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 103358) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 061312) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2022-04-04 |