| NPI | 1013075159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 50253) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: RI 02938) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2014-01-16 |