| NPI | 1740544303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CA 109541) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056780) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: NY 056780) | |
| 122300000X Dentist (Licence: WA 60737991) | |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2024-02-19 |