| NPI | 1316532914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 107364) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 107364) |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2026-07-28 |