| NPI | 1306406764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 108043) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 7230) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2023-08-30 |