| NPI | 1962635870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 8985) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 8813) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12011910A) | |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2014-07-18 |