| NPI | 1649342601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 7512) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2021015926) |
| 1223G0001X Dentist, General Practice (Licence: TX 11852) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2025-10-22 |