| NPI | 1235469529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 59807) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 053283-1) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2018-05-23 |