| NPI | 1235393224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 8664) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 8664) |
| 1223P0300X Dentist, Periodontics (Licence: NC 9231) | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2023-03-14 |