| NPI | 1154304277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 7853) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 7853) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2011-06-08 |