| NPI | 1215262225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 100140) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH 30-023111) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2022-09-30 |