| NPI | 1578706636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CA 56883) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: FL DN18092) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: OR D7814) | |
| Enumeration Date | 2009-04-19 |
| Last Update Date | 2014-06-23 |