| NPI | 1275838187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: MN 13347) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 10360) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2017-02-24 |