| NPI | 1356818884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS102594) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 40906) |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2024-08-08 |