| NPI | 1861999864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OR D11970) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: WA 61039600) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-07 |
| Last Update Date | 2024-09-09 |