| NPI | 1629524848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA 00206349) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS100415) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2025-07-22 |