| NPI | 1487729786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DE G10001184) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 13505) |
| 1223G0001X Dentist, General Practice (Licence: PA DS036982) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2016-04-17 |