| NPI | 1902990401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 568) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 5561) |
| 1223P0300X Dentist, Periodontics (Licence: KY 567) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2025-09-11 |