| NPI | 1578789533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 7646) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: KY 7646) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2009-09-16 |