| NPI | 1942499082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WI 6962) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 58118) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2020-03-04 |