| NPI | 1659338523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 56340) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 051522-1) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2011-03-01 |