NPI | 1548612617 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401416133) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 12362) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-07-12 |
Last Update Date | 2023-09-28 |