| NPI | 1952706087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D11234) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63651) |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2020-06-26 |