| NPI | 1467867663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 103313) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 30134) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2022-03-11 |