| NPI | 1659061851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 111705) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA F5672291) |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2025-11-20 |