| NPI | 1063728376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA DDS103489) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: SC 8772) |
| 1223E0200X Dentist, Endodontics (Licence: GA DN015132) | |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2019-02-19 |