| NPI | 1457519043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 58974) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8875) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2025-12-01 |