| NPI | 1124292388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 59955) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: HI 2110) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2023-10-17 |