| NPI | 1861582801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 54854) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NV S7-128) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2022-09-22 |