| NPI | 1477911618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MT DEN-DEN-LIC-13340) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2015021100) |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2022-07-21 |