| NPI | 1275512444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D7386) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MN D7386) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2021-04-26 |