| NPI | 1528127917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D10168) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 122360001x) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2007-07-08 |