| NPI | 1760500169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 50973) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 20727) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2013-10-30 |