| NPI | 1366995169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN D14151) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NC 151112) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2020-12-10 |