| NPI | 1689985509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 5653994-9922) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 105496) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2020-10-27 |