| NPI | 1609250372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KY 9622) |
| Additional Taxonomies | 1223X0008X Dentist Oral and Maxillofacial Radiology (Licence: KY 9622) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2016-04-28 |