| NPI | 1194394288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D14847) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN26108) |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2023-09-13 |