| NPI | 1245607837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 64987) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D14185) |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2023-02-07 |