| NPI | 1255957882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA DDS106879) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 36192) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2024-07-18 |