| NPI | 1265780175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 61834) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 61834) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2023-05-15 |