| NPI | 1811924202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 50621) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NV S7-75) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2014-05-08 |