| NPI | 1609163229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OK 6291) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6291) |
| Enumeration Date | 2011-07-04 |
| Last Update Date | 2023-10-25 |