| NPI | 1154391274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MN S3) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN S3) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN S3) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2026-02-09 |