| NPI | 1275681868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 58223) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D5946) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2011-06-14 |