| NPI | 1063580736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DE GI-0001319) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: AK 951) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2012-09-25 |