| NPI | 1265795538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 29312) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6388) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2016-10-19 |