| NPI | 1134323660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 51004) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 51004) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2015-07-10 |