| NPI | 1922319169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CA 100277) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 25568) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2022-04-07 |