| NPI | 1902224975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN20727) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY KY 9443) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2016-09-24 |