NPI | 1205218922 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103479) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 22153) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2015-06-19 |
Last Update Date | 2022-03-02 |