NPI | 1013147347 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: DE G1-0001391) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS037854) |
Enumeration Date | 2009-07-21 |
Last Update Date | 2017-04-26 |