| NPI | 1245229202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 04017) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 04017) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2008-10-08 |