| NPI | 1417075649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 56047) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 050257) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2008-05-07 |