| NPI | 1992017156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN18989) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN18989) |
| Enumeration Date | 2010-07-05 |
| Last Update Date | 2023-08-22 |