| NPI | 1386059772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA DDS107031) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039876) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2021-10-26 |