| NPI | 1831502715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 105966) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 058628) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2022-02-02 |