| NPI | 1508578477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA DDS105759) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA DDS105759) |
| Enumeration Date | 2022-12-22 |
| Last Update Date | 2022-12-22 |