| NPI | 1275741860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 85279) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2014044094) |
| 122300000X Dentist (Licence: AR 3972) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2022-09-15 |