| NPI | 1003303579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN123295) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN23395) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2024-01-13 |