| NPI | 1497730196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 7256 898) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 7256) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2013-10-16 |