| NPI | 1811008030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 3683) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: KY 148) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |