| NPI | 1124294673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 101992) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 4070) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2022-03-25 |