| NPI | 1306026679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV s7-88C) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 56428) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2017-04-12 |