| NPI | 1679941371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 7148) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 30975) |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2019-07-02 |