| NPI | 1639488034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 60241) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 60241) |
| 1223G0001X Dentist, General Practice (Licence: IN 12011522A) | |
| 1223G0001X Dentist, General Practice (Licence: IL 019.028258) | |
| Enumeration Date | 2010-10-02 |
| Last Update Date | 2022-04-04 |