| NPI | 1699037325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 6942) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401414362) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2024-03-19 |