| NPI | 1114368776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D11255) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62455) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2020-07-31 |