| NPI | 1558772863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: MN 13930) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN 13930) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2018-06-12 |