| NPI | 1235341991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 9411) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 6539) |
| 122300000X Dentist (Licence: KY 9411) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2015-01-20 |