| NPI | 1144470295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D13906) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901021438) |
| 1223G0001X Dentist, General Practice (Licence: TX 31604) | |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2026-08-29 |