| NPI | 1548799661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 106384) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MO 2019003577) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2021-07-30 |