| NPI | 1902270705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL Dn21447) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 21447) |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2019-01-23 |