| NPI | 1154733020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64892) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D11471) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2023-08-29 |