| NPI | 1114157583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D-5342) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D9309) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2022-11-09 |