| NPI | 1417981606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 51010) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ 4999) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2024-04-18 |