| NPI | 1558385377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D11694) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN 11694) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-12-06 |