| NPI | 1518170299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 33440) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 33440) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2010-09-22 |