| NPI | 1780024505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 106930) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 8758) |
| 1223E0200X Dentist, Endodontics (Licence: AZ D008758) | |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2021-09-05 |