| NPI | 1790318152 |
|---|---|
| Former Name | KEVIN MANUEL RODRIGUEZ SANTOS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 17358) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401417104) |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2023-03-21 |