| NPI | 1851791131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CA 63960) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 63960) |
| Enumeration Date | 2014-08-24 |
| Last Update Date | 2022-08-15 |