| NPI | 1275980724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CA 102057) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 102057) |
| Enumeration Date | 2016-05-14 |
| Last Update Date | 2020-08-19 |