NPI | 1578911087 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 10050) |
Additional Taxonomies | 122300000X Dentist (Licence: KY 10050) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-05-25 |
Last Update Date | 2018-03-30 |