| NPI | 1760856009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 19108) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 19108) |
| Enumeration Date | 2015-11-24 |
| Last Update Date | 2015-11-24 |