| NPI | 1982762753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 5822) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6941) |
| 122300000X Dentist (Licence: TN 11828) | |
| 122300000X Dentist (Licence: TX 22460) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2024-05-15 |