| 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 |