| NPI | 1588073506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30590) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63453) |
| 1223G0001X Dentist, General Practice (Licence: KS 61120) | |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2020-08-05 |