SpecialtyDentist
LocationPort Charlotte, FL
NPI1528494788
License statusActive
License number17619
License expires02/28/2028
Disciplinary recordClear
Last verified by WhoIsMyDentist: 2026-07-17. Sourced from the U.S. federal NPI registry and state dental board licensing (federal record dated 09/19/2013). If this looks outdated, use "Report an issue" on this profile to suggest a correction.