| NPI | 1316510209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 106582) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 106582) |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2023-04-10 |