| NPI | 1619005949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 6561) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WY 1120) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2015-02-22 |