| NPI | 1366112377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 106748) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 106748) |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2024-07-08 |