| NPI | 1649687674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13468) |
| Additional Taxonomies | 1223D0001X Dentist Dental Public Health (Licence: MN D13468) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2014-07-22 |