| NPI | 1336541135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN23156) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021229) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2018-04-19 |