| NPI | 1447705918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA DDS100390) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 100390) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2020-07-10 |