NPI | 1528443751 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MN S156) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MN R635) |
Enumeration Date | 2015-07-29 |
Last Update Date | 2020-11-24 |