| NPI | 1609894864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 43267) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 43267) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-11-29 |