| NPI | 1932652344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 6893) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 100584) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2016-12-01 |