NPI | 1205948270 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: CA DS36308) |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA DS36308) |
1223X2210X Dentist Orofacial Pain (Licence: CA DS36308) | |
174400000X Specialist (Licence: CA 36308) | |
332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: CA 36308) | |
Enumeration Date | 2006-08-31 |
Last Update Date | 2022-07-07 |