| NPI | 1164770376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008970) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6441) |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2021-11-08 |