| NPI | 1811410301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 13606) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 101811) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2024-08-05 |