| NPI | 1780955542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 6569) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2004032896) |
| 1223G0001X Dentist, General Practice (Licence: CA 35652) | |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2015-03-19 |