| NPI | 1598943441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN D12640) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 9364) |
| Enumeration Date | 2008-02-02 |
| Last Update Date | 2012-09-28 |