| NPI | 1356755474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN21734) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9463) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2022-01-03 |