| 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 |