| NPI | 1578587754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D8509) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MN D8509) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |