| NPI | 1831196740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN0010185) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 010830) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2012-01-03 |