| NPI | 1629459227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 64541) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: FL DN 210013) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2015-06-28 |