NPI | 1699889352 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN16280) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN 16280) |
Enumeration Date | 2006-08-19 |
Last Update Date | 2023-03-07 |