| NPI | 1801182944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 6457) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 27092) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2013-01-22 |