NPI | 1992153167 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 3440) |
Additional Taxonomies | 122300000X Dentist (Licence: CO 3440) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-05-28 |
Last Update Date | 2018-10-15 |