| NPI | 1851487995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CA 56958) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: OH 30022362) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2016-09-19 |