| NPI | 1700864584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN 11473) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MN D11473) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2021-07-06 |