| NPI | 1366503385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 53739) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 53739) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2021-11-03 |