NPI | 1508394644 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 102387) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 102387) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-06-02 |
Last Update Date | 2024-05-01 |