| NPI | 1336248178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401411273) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN15790) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2016-03-07 |