| NPI | 1336199314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D12244) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D12244) |
| 122300000X Dentist (Licence: NE 6342) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN 12244) | |
| 1223P0700X Dentist, Prosthodontics (Licence: MN D12244) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2020-08-05 |