| NPI | 1497863534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 43860) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CO 00202465) |
| 1223P0300X Dentist, Periodontics (Licence: NV S4-61C) | |
| 1223P0300X Dentist, Periodontics (Licence: WA DE60568675) | |
| 1223P0300X Dentist, Periodontics (Licence: NM DB-2026-0316) | |
| 1223P0300X Dentist, Periodontics (Licence: ID 1381828) | |
| 1223P0300X Dentist, Periodontics (Licence: OR D10296) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2026-10-06 |