| NPI | 1508967704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D10405) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 37698) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2021-04-14 |