| NPI | 1356791164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN s181) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN ff72) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2022-10-24 |