| NPI | 1154680296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 65249) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 057036) |
| 1223E0200X Dentist, Endodontics (Licence: CT 10745) | |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2021-01-27 |