| NPI | 1588493530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DE G9-0010553) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS045403) |
| Enumeration Date | 2024-07-29 |
| Last Update Date | 2026-06-16 |