Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | AP2505 | FL |
NPI | 1174820567 |
---|---|
Provider Name | Bruno Maximillian Dinicola |
First Address | Lakeland, FL 33809-7215 |
Second Address | Lakeland, FL 33809-7215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2011 |
Last Update Date | 21/02/2011 |