| NPI | 1861663148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 56385) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 215521) |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2017-01-25 |