| NPI | 1225559198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: TN 10701) |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain (Licence: KY 9930) |
| 122300000X Dentist (Licence: KY 9930) | |
| 1223G0001X Dentist, General Practice (Licence: KY 9930) | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2025-03-09 |