| NPI | 1144939091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA DDS111275) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00205400) |
| Enumeration Date | 2022-11-18 |
| Last Update Date | 2025-07-18 |