| NPI | 1225147432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5177) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 6988) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-07-03 |