| NPI | 1669125746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS107221) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA DDS107221) |
| Enumeration Date | 2022-01-30 |
| Last Update Date | 2025-09-23 |