| NPI | 1205917507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: UT 6262031-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 6262031-9921) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2023-08-25 |