| NPI | 1740594571 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DE G3-0000378) | 
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN123815) | 
| 122300000X Dentist (Licence: OR D11020) | |
| 122300000X Dentist (Licence: AZ D008567) | |
| 1223G0001X Dentist, General Practice (Licence: SC DGD.10935) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D11020) | |
| Enumeration Date | 2010-08-04 | 
| Last Update Date | 2025-06-30 |