| NPI | 1447614318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D14048) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 1002273-15) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2022-08-22 |