| NPI | 1366002875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 35145) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OK 7190) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2019-06-21 |