| NPI | 1225521669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DRPM2326) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-09558) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2021-06-09 |