| NPI | 1144217985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5456) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 5456) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2022-10-18 |