| NPI | 1811953037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: FL DTP 313) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: VA 0401004921) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2023-03-07 |