| NPI | 1508968033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CA D25263) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: CA D25263) |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2010-05-04 |