| NPI | 1073935128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CA DDS101038) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NY 056889-1) |
| Enumeration Date | 2014-01-09 |
| Last Update Date | 2020-01-31 |