| NPI | 1558371633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401413575) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN012570) |
| 122300000X Dentist (Licence: OK 6340) | |
| 122300000X Dentist (Licence: IN 12011228A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2014-08-12 |