NPI | 1619769684 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN R899) |
Additional Taxonomies | 122300000X Dentist (Licence: MN R899) |
Enumeration Date | 2025-05-19 |
Last Update Date | 2025-06-05 |