| NPI | 1649709437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 7137) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA DDS-09427) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2019-04-08 |