| NPI | 1093054157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: NY 062947-01) |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain (Licence: NJ 22DI02542300) |
| Enumeration Date | 2013-02-10 |
| Last Update Date | 2024-02-07 |