| NPI | 1568629277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: DE G1-0001264) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IN 12011123A) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2010-08-03 |