| NPI | 1710411715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 119) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO Den.00203438) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2020006360) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2021-03-29 |