| NPI | 1669674974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 44077) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 44077) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2015-02-13 |