| NPI | 1881658946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: KY 7737) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: KY 7737) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2015-07-17 |