| NPI | 1528415742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: KY 10740) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D13666) |
| 122300000X Dentist (Licence: KY 10740) | |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2023-10-03 |