| NPI | 1245679034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 972) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9563) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2016-10-13 |