| NPI | 1952371981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NM 1291) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MN 8366) |
| 1223P0300X Dentist, Periodontics (Licence: WY 759) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2007-07-08 |