| NPI | 1205284098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 9750) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9750) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2026-05-20 |