| NPI | 1851521900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 46455) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 054668) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2018-07-18 |