| NPI | 1598789786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: KY 6772) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 6772) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2008-04-25 |