| NPI | 1245254820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN15110) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AL FLDD15110) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-09 |