| NPI | 1285811828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CA 59158) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: MA 21763) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2013-08-30 |