| NPI | 1003335308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 7434) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 10380547-9922) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2021-05-17 |