| NPI | 1063864114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CA CA100300) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 100300) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2024-10-03 |