NPI | 1265532451 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 8166) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12012166A) |
1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: KY 8166) | |
208D00000X General Practice (Licence: KY FL034) | |
1223P0221X Dentist, Pediatric Dentistry (Licence: MN D12322) | |
1223P0221X Dentist, Pediatric Dentistry (Licence: NY 057865) | |
Enumeration Date | 2006-09-25 |
Last Update Date | 2016-08-11 |