| NPI | 1679868921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 62328) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CA 62328) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2013-10-24 |