| NPI | 1811578529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: FL DN29304) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN29304) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: TN 11686) | |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2024-07-10 |