| NPI | 1770998213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DE G1-0001363) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA RES-30414) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2015-08-10 |