| NPI | 1013095421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 8116) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8116) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2010-01-28 |