| NPI | 1093012403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN21100) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401413210) |
| Enumeration Date | 2011-02-21 |
| Last Update Date | 2017-04-13 |