| NPI | 1336752971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 105354) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 105354) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2024-08-09 |