| NPI | 1275649394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN 10211) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WI 3179) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2019-07-30 |