| NPI | 1093826208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 3521) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: KY 152) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |