| NPI | 1588811426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AK 1476) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 033100) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2015-01-08 |