| NPI | 1881743219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 32171) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA DN 32171) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: PA 21634) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2010-09-23 |