| NPI | 1518097211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV 5611) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 29785) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-07-08 |