| NPI | 1992846885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 4207) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: KY 4207) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2010-06-15 |