| NPI | 1114032349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 26049) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 2226049) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2020-10-06 |