| NPI | 1811425879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 104656) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 104656) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2022-12-16 |