| NPI | 1902150352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV S7-143) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62986) |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2024-05-11 |