| NPI | 1710141783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 57293) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 1855031) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2021-09-08 |