| NPI | 1588150841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 103133) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 103133) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2021-09-10 |