| NPI | 1902044068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 55484) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NC 150575) |
| Enumeration Date | 2009-01-28 |
| Last Update Date | 2013-09-30 |