| NPI | 1184944050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA 60260894) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 59053) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2020-11-05 |