| NPI | 1942318555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DE BK5934612) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DE G1-0001086) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2021-04-15 |