| NPI | 1366445777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DE G1-0001118) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 9885) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2012-04-03 |