| NPI | 1437165651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D10738) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SD M826) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |