| NPI | 1578876595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: FL DN 19146) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 19146) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2023-01-16 |