| NPI | 1316975568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 10185) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 7092) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2007-07-08 |