| NPI | 1477639466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN 7412) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: MN D7412) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2007-07-08 |