| NPI | 1073953840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 109076) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 10058) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2025-06-04 |