| NPI | 1871828277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 51660) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OR D9353) |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2022-01-03 |