| NPI | 1013521087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 7620) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 36657) |
| Enumeration Date | 2020-09-07 |
| Last Update Date | 2022-06-30 |