| NPI | 1609228527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 100323) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 100323) |
| 1223G0001X Dentist, General Practice (Licence: CA 100323) | |
| Enumeration Date | 2016-07-02 |
| Last Update Date | 2022-07-26 |