| NPI | 1053742130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 59994) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 59994) |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2024-03-08 |