| NPI | 1487000592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 100200) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 100200) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2022-10-16 |