| NPI | 1376855098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D14811) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6545-015) |
| 1223G0001X Dentist, General Practice (Licence: WI 64545-15) | |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2022-07-19 |