| NPI | 1487888228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 8773) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12011379A) |
| 1223D0001X Dentist, Dental Public Health (Licence: KY 8773) | |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2013-05-14 |