NPI | 1841858420 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: CA 103859) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2019-05-30 |
Last Update Date | 2022-09-04 |