| NPI | 1700298338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 6604) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D10582) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2021-11-03 |