| NPI | 1982780946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4520) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60444) |
| 1223G0001X Dentist, General Practice (Licence: NH 03692) | |
| 1223G0001X Dentist, General Practice (Licence: WA DE 60231370) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2015-07-02 |