| NPI | 1194989624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D12580) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IA 08892) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2011016146) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2012-07-30 |