| NPI | 1447370184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OR D8523) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 57812) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2009-07-19 |