| NPI | 1427279082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 59127) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NE 6430) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2010-06-07 |