| NPI | 1417700949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D15096) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 13826) |
| Enumeration Date | 2024-04-05 |
| Last Update Date | 2025-10-07 |