| NPI | 1386191559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CA DDS104204) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA DDS104204) |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2023-05-10 |