| 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 |