| NPI | 1366671109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 58199) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 052956) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2009-07-14 |