| NPI | 1508419797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA DDS107368) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1858442) |
| 1223P0300X Dentist, Periodontics (Licence: MA DN1858442) | |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2022-08-09 |