| NPI | 1043278153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 53122) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: AZ D009224) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-02-26 |