| NPI | 1013983170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D15378) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SD M722) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2025-10-16 |