| NPI | 1265713002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: MO 2011028226) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2011028226) |
| 1223G0001X Dentist, General Practice (Licence: MO 2011028226) | |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2026-07-24 |