NPI | 1952838773 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 102882) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 102882) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-05-11 |
Last Update Date | 2024-05-01 |