| NPI | 1093226177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 106207) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: VA 0401415851) |
| 1223E0200X Dentist, Endodontics (Licence: NV S7-111C) | |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2022-06-18 |