| NPI | 1205049137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 60373) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 60373) |
| 122300000X Dentist (Licence: NY 053389) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2024-07-22 |