| NPI | 1770639981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK D5393) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D8106) |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2009-03-30 |