| NPI | 1831843150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CT 14090) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: FL DN27129) |
| Enumeration Date | 2022-02-06 |
| Last Update Date | 2024-07-22 |