| NPI | 1295700383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D11882) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 49648) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2017-03-28 |