| NPI | 1164857736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 62816) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62816) |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2016-09-09 |