| NPI | 1043957038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN D14726) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MN 0) |
| 122300000X Dentist (Licence: MN 1111111111111) | |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2022-05-25 |