| NPI | 1386172799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00203862) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6932) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2019-08-15 |