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 |