| NPI | 1891865861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 43300) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NV S7-129C) |
| 261QD0000X Clinic/Center, Dental (Licence: MN S179) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2026-05-28 |