| NPI | 1902115835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 5170) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 32845) |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2018-04-16 |