| NPI | 1730659459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 107551) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858728) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2023-07-28 |