| NPI | 1043662083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DE G1-0011478) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040942) |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2021-11-29 |