| NPI | 1841301728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 47562) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA DDS47562) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-07-27 |