| NPI | 1891782603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN D11763) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NE 6870) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2021-04-27 |