| NPI | 1013086032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: MN D9110) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CO 5474) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-08 |