| NPI | 1174678205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS0296924L) |
| Additional Taxonomies | 122300000X Dentist (Licence: DE G1-0001195) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2007-07-08 |