| NPI | 1144584046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 65343) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 244202) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2022-10-19 |