| NPI | 1992864367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 202464) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 50121) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2015-04-28 |