| NPI | 1093454514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 113537) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 063241) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2026-09-11 |