| NPI | 1720465321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 1720465321) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 1720465321) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2021-11-08 |