| NPI | 1790361319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA DDS107129) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AZ D012324) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-08-28 |