| NPI | 1851534226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 7251) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8404733-9922) |
| 122300000X Dentist (Licence: TX 25308) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2020-01-30 |