| NPI | 1043882103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 7763) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D11449) |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2024-03-05 |