| NPI | 1437447984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 31121) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6284) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2023-12-12 |