| NPI | 1598206476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 104768) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 060279) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2021-04-14 |