| NPI | 1659697415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN18955) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN18955) |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2022-07-21 |