| NPI | 1740253004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS035599) |
| Additional Taxonomies | 122300000X Dentist (Licence: DE G1-0001263) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2010-05-11 |