| NPI | 1104186113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 6416) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2012016058) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2012-05-30 |