| NPI | 1225306483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 6108) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 6108) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2020-03-04 |