| NPI | 1740486612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ND 2125) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D12881) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2018-04-27 |