| NPI | 1982867917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 55105) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 060952-01) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2021-02-25 |