| NPI | 1194959296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 6247) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D5874) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2019-12-12 |