| NPI | 1851334775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| 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 |