| NPI | 1932217403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: WA DE00008184) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00008184) |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2015-02-04 |