| NPI | 1073751152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 50321) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 054309-1) |
| Enumeration Date | 2009-01-28 |
| Last Update Date | 2013-12-30 |