| NPI | 1144392515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: AZ 5356) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ 5356) |
| 1223E0200X Dentist, Endodontics (Licence: AZ 5356) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2026-04-28 |