| NPI | 1861605370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 4727) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 4605) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2018-03-17 |