| NPI | 1629091244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN29747) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS029796L) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: DC DEN1001186) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 14747) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2025-10-30 |