| NPI | 1548715758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: KY 9847) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9847) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2020-09-08 |