| NPI | 1154681385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA DDS107483) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 22471) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2023-09-29 |