| NPI | 1033342464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 6334) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24940) |
| 122300000X Dentist (Licence: TX 0024940) | |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2011-10-04 |