| NPI | 1568710820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 60527) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204146) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2023-04-28 |