| NPI | 1225116403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 7203) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 7203) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2015-12-29 |