| NPI | 1710617410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 11064) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DRPM2443) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2025-06-01 |