| NPI | 1730420910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN 13948) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 7101) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D13948) | |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2023-04-27 |