| NPI | 1639482896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D10569) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 59374) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2018-04-04 |