| NPI | 1316306236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CT 12678) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 101603) |
| 1223G0001X Dentist, General Practice (Licence: CA DDS101603) | |
| Enumeration Date | 2016-02-19 |
| Last Update Date | 2020-11-05 |