| NPI | 1942669312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 103857) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 059332-1) |
| 1223E0200X Dentist, Endodontics (Licence: CA DDS103857) | |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2019-07-16 |