| NPI | 1700353372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV S7-126C) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 103145) |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2023-05-17 |