| NPI | 1891355848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DE G1-0011487) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS042548) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2023-11-21 |