| NPI | 1336554864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN21113) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN21113) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2021-01-12 |