| NPI | 1497968333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 60328) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: FL 17888) |
| 1223E0200X Dentist, Endodontics (Licence: WA 00010685) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-04-10 |