| NPI | 1407862626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY ky. 5141) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY Indiana 12010320A) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OH Ohio 30.019661) | |
| 1223G0001X Dentist, General Practice (Licence: KY 5141) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2008-06-12 |