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 |