| NPI | 1811041767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY KY4615) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY KY4615) |
| 1223D0001X Dentist, Dental Public Health (Licence: KY ky4615) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2012-01-10 |