| NPI | 1629362363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 103783) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 26498) |
| Enumeration Date | 2011-05-29 |
| Last Update Date | 2023-01-12 |