| NPI | 1629484274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 107379) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 058339-1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2023-03-31 |