| NPI | 1841585445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D12959) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D12959) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2016-08-26 |