| NPI | 1972866218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OK 6559) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 27930) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2014-03-17 |