| NPI | 1295405777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D14997) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN26235) |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2023-09-21 |