| NPI | 1205152899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 7533) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY P64647) |
| 122300000X Dentist (Licence: OR D9441) | |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2022-02-11 |