| NPI | 1598746687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D9864) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 27908) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2014-07-22 |