| NPI | 1467445809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 39263) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: HI DT 2116) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2009-08-12 |