| NPI | 1255784633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DRPM2325) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 30466) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2021-06-07 |