| NPI | 1013417641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 17513) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 42895) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2022-12-02 |