| NPI | 1467455360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D6996) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR D6996) |
| 122300000X Dentist (Licence: CA 38336) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2007-07-08 |