| NPI | 1003063652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 57584) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 22271) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2014-07-23 |