| NPI | 1609097120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 38622) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NV LL-598-23) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2023-10-30 |