| NPI | 1982120424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA DDS101848) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS101848) |
| 122300000X Dentist (Licence: CO 00205077) | |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2023-12-10 |