| NPI | 1720696198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA DDS107635) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN R783) |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2023-02-21 |