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 |