| NPI | 1447588199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 6000063) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 58995) |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2022-07-28 |