| NPI | 1972921450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MT 11353) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30-024412) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2016-07-22 |