| NPI | 1972890226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 61215) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412917) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2013-08-24 |