| NPI | 1023180171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: FL DN16341) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: MA 21057) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2022-07-21 |