NPI | 1720494370 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 1002288-15) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 30209) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 059610) | |
Enumeration Date | 2014-07-03 |
Last Update Date | 2021-03-26 |