| NPI | 1023397023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN0013359) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 11194) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 0007070) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 011461) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2011-08-08 |