| NPI | 1912166869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401413912) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 56289) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2024-01-10 |