| NPI | 1952515967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX TX 21281) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6555) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2015-05-14 |