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 | 2019-09-09 |