| NPI | 1457542284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 6093) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 5497384-9922) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2010-02-24 |