| NPI | 1104484476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401418327) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN24167) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2024-06-09 |