| NPI | 1659386100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 26776) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA DE60433577) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2016-10-12 |