| NPI | 1801463708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 105679) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS105679) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2023-11-27 |