| NPI | 1376645440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OK 58) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 5814) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2018-08-20 |