| NPI | 1154813202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 11106) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0442000454) |
| 122300000X Dentist (Licence: NC 11037) | |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2024-07-23 |