| NPI | 1215175724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: KY 8659) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 4332) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2024-02-13 |