| NPI | 1619969276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ D010172) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 52806) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2021-07-06 |