| NPI | 1043488836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MN D12597) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN R386) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2011-04-07 |