| NPI | 1922422070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 63257) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 63257) |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2019-04-10 |