| NPI | 1235264292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 5727) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OK 5727-51) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2024-04-10 |