| NPI | 1982449658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D1512) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D15112) |
| Enumeration Date | 2024-06-26 |
| Last Update Date | 2025-07-09 |