| NPI | 1851976096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NV LL-556-21) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 108923) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-09 |
| Last Update Date | 2023-07-19 |