| NPI | 1992072284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OR D10031) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 59900) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2014-07-15 |