| NPI | 1861036824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CA DDS107127) |
| Enumeration Date | 2019-11-03 |
| Last Update Date | 2023-07-14 |