| NPI | 1225138852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 3776) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 3776) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 3776) | |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2015-01-20 |