| NPI | 1043541907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: AZ D07838) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 7838) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D07838) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ D07838) | |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2024-06-10 |