| NPI | 1326102849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN26712) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 5858) |
| 122300000X Dentist (Licence: CO 9315) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2022-08-23 |