| NPI | 1053329185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 3138) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 8242) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2025-08-19 |