| NPI | 1932199163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR 4909) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 24423) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IA 5828) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2023-03-07 |