| NPI | 1891109765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO AD.0000519) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401416088) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 33860) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2018-11-19 |