| NPI | 1134571565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DE G1-0001435) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS040918) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2020-10-25 |