| NPI | 1184605776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CA 57758) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: MA 21461) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2022-02-02 |