NPI | 1871904896 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 63369) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 63369) |
Enumeration Date | 2014-05-13 |
Last Update Date | 2021-02-12 |