| NPI | 1285915611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MN S172) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MN TBP) |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2025-01-13 |