| NPI | 1194108506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 6752) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6752) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2015-07-02 |