NPI | 1851334775 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MN D10042) |
Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN D10042) |
Enumeration Date | 2006-06-14 |
Last Update Date | 2007-07-08 |