| NPI | 1679834899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 9167) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9167) |
| 122300000X Dentist (Licence: IL 019.030337) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2017-03-02 |