| NPI | 1154581403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 56503) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 009864) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2010-09-24 |