| NPI | 1104833730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 5900) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OK 62) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2015-05-15 |