| NPI | 1922434562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D10575) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 64392) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 056971-1) | |
| Enumeration Date | 2013-09-14 |
| Last Update Date | 2020-11-30 |