| NPI | 1821341819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 61864) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NV S4-112C) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2019-06-20 |