| NPI | 1720242472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 57166) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57166) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2022-07-21 |