| NPI | 1164701033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: DE G1-0001328) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS038755) |
| 122300000X Dentist (Licence: DE G1-0001328) | |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2014-05-13 |