| NPI | 1316033004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 4084) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 195) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |