| 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 |