| NPI | 1134805153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 7774) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 13699) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2025-09-24 |