| NPI | 1225261100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D7475) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D11451) |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2020-08-26 |