| NPI | 1639379142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 59342) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 8551) |
| 122300000X Dentist (Licence: NC 150635) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2020-04-05 |