| NPI | 1952520710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D15386) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 9930) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2025-09-26 |