| NPI | 1154313195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 7940) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 5279) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2024-08-21 |