| NPI | 1386923464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 60423) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415060) |
| 122300000X Dentist (Licence: CA 60423) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401415060) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2023-03-22 |