| NPI | 1902899883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OR 4651) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: CA 24157) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2007-07-08 |