| NPI | 1578770970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5993) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 18313) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2015-09-03 |