| NPI | 1780990168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CA 108827) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 10238) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2024-04-11 |