| NPI | 1215388954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN D13696) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D13696) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2023-06-28 |