| NPI | 1609321199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 100739) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 100739) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2023-09-21 |