| NPI | 1306239702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 101752) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901021995) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2022-01-20 |