| NPI | 1912314139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DE G10001408) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15898) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2018-10-08 |