| NPI | 1992237481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D14155) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WV 4234) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2019-05-29 |