NPI | 1770952426 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN21339) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN21339) |
Enumeration Date | 2015-09-23 |
Last Update Date | 2022-07-21 |