| NPI | 1902878531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 7979) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: KY 7979) |
| 1223G0001X Dentist, General Practice (Licence: KY 7979) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2014-06-23 |