| NPI | 1487719209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN 83A80) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN 41-1404115) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2007-07-08 |