| NPI | 1376064105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA DDS110725) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1857627) |
| Enumeration Date | 2017-07-01 |
| Last Update Date | 2025-01-24 |