| NPI | 1821287467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 6689) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 6689) |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2015-01-15 |