| NPI | 1972639870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 6009) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: KY 6009) |
| 1223G0001X Dentist, General Practice (Licence: KY 6009) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 6009) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2015-01-16 |