| NPI | 1336890185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 110132) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013957A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-01-13 |
| Last Update Date | 2024-06-21 |