| NPI | 1881926509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OK 30823) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 6860) |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2015-01-29 |