| NPI | 1538201215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0002254) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DE g1-0000893) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2021-10-30 |