| NPI | 1174557938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 18699) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 18699) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2014-05-01 |