| NPI | 1295894004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 5247) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OK 5247) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2025-05-15 |