| NPI | 1831851047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D14667) |
| Additional Taxonomies | 122300000X Dentist (Licence: ND 2444) |
| 1223G0001X Dentist, General Practice (Licence: ND 2444) | |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2021-10-06 |