| NPI | 1437445400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 6347) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 3833) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2016-02-03 |