| NPI | 1295524213 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DDS110547) |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2026-07-16 |