| NPI | 1306100607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DE G1-0001354) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS039134) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2016-03-13 |