| NPI | 1780886507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D11888) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 35134) |
| 1223G0001X Dentist, General Practice (Licence: NY 040262) | |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2024-08-29 |