| NPI | 1801056080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 60975) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AK 1334) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 10424) | |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2011-11-18 |