NPI | 1497077895 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 60128) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 054980) |
1223G0001X Dentist, General Practice (Licence: CA 60128) | |
Enumeration Date | 2010-02-25 |
Last Update Date | 2014-06-10 |