| NPI | 1407183205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 58968) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NV 6153) |
| Enumeration Date | 2009-11-16 |
| Last Update Date | 2011-09-15 |