| NPI | 1386061349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL D21099) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA D039540) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2026-07-01 |