| NPI | 1427241223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN19366) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401411952) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2015-11-04 |