| NPI | 1770660508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN8849) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 12249) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-03-07 |