| NPI | 1831638329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 102818) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DR60757069) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2023-06-27 |