| NPI | 1336436872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL dn26676) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 63707) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2025-07-31 |