| NPI | 1215135579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 59329) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0401413737) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2021-11-22 |