| NPI | 1568774719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN22333) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 0555961) |
| Enumeration Date | 2010-07-03 |
| Last Update Date | 2018-11-05 |