| NPI | 1083695100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 48747) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OK 56) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2008-07-11 |