| NPI | 1033302914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 56650) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 052298) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2012-01-31 |