| NPI | 1841291523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D15377) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 5442) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2025-10-20 |