| NPI | 1457999815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 107533) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NE 128) |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2022-07-06 |