| NPI | 1154431088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OK 69) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 8685) |
| 122300000X Dentist (Licence: OK 3232) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-08-28 |