| NPI | 1538578984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA DDS101217) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 6556) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2026-05-24 |