| NPI | 1558779579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 62538) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OR D10054) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2021-11-11 |