| NPI | 1912290412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 62268) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 055562) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2020-05-14 |