| NPI | 1073946927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 102581) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 8805) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2019-02-20 |