| NPI | 1457579344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D9882) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D9882) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2013-11-05 |