| NPI | 1063424844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 104801) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA 61041300) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NH 3134) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2023-09-21 |