| NPI | 1811053960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 52953) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA 21427) |
| Enumeration Date | 2006-12-30 |
| Last Update Date | 2010-01-19 |