NPI | 1558066506 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN10581) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN10581) |
Enumeration Date | 2023-03-31 |
Last Update Date | 2023-03-31 |