| NPI | 1972725844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 56021) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NM DD2835) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D6719) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-10-11 |