| NPI | 1356365035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: FL DN18130) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: CA 45651) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2023-12-01 |