| NPI | 1093733081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 110080) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: HI 2101) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2024-11-02 |