| NPI | 1548525785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 61419) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61419) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2019-08-19 |