| NPI | 1164713806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 7165) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 60332) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2020-11-16 |