| NPI | 1992044424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: KY 9260) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9260) |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2021-04-14 |