| NPI | 1154645471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D9958) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 61251) |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2022-05-23 |