| NPI | 1790097905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4406) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 0025592) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2021-04-15 |