| NPI | 1538382569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 63089) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN16639) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2021-09-24 |