| NPI | 1629282611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA DDS59108) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS59108) |
| 1223G0001X Dentist, General Practice (Licence: NY 052912) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2019-07-26 |