| NPI | 1609242411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 108114) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IN 12012407A) |
| Enumeration Date | 2015-08-16 |
| Last Update Date | 2022-09-23 |