| NPI | 1346843158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 126800000X Dental Assistant (Licence: CA 90325) |
| Additional Taxonomies | 246RP1900X Technician, Pathology, Phlebotomy (Licence: CA K7L7R5Z9) |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2020-11-16 |