NPI | 1104379718 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 103082) |
Additional Taxonomies | 122300000X Dentist (Licence: NV 7356) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-07-31 |
Last Update Date | 2024-08-27 |