| NPI | 1619295771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: FL DN 18887) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: GA DN013733) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2010-05-12 |