| NPI | 1346520020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 33931) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 60870) |
| 122300000X Dentist (Licence: OK 6327) | |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2020-01-09 |