| NPI | 1164789061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 100261) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D11939) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60540505) | |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2024-04-24 |