| NPI | 1326271610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: UT 10458666-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 58586) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2023-03-27 |