| NPI | 1588155824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OK 7031) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2018017159) |
| 1223G0001X Dentist, General Practice (Licence: OK 7031) | |
| 1223G0001X Dentist, General Practice (Licence: KS 62064) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 39371) | |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2024-06-17 |