| NPI | 1962885848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-139) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 64573) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2021-03-06 |