| NPI | 1275991721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 100181) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MT 21542) |
| Enumeration Date | 2016-01-29 |
| Last Update Date | 2022-10-10 |