| NPI | 1225775299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 109690) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 109690) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA 15503) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2024-09-16 |