| NPI | 1992026363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 8883) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8883) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2012-08-03 |