| NPI | 1881733947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CA 28943) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CA 28943) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2008-07-15 |