| NPI | 1477068906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 105699) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 33642) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 105699) | |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2022-10-21 |