| NPI | 1467545087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN23234) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN122206) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2021-05-19 |