| NPI | 1639347917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13709) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D13709) |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2024-10-14 |