| NPI | 1902229164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 65263) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CO 202150) |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2019-11-19 |