| NPI | 1285640383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: MS OP-6042-23) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 2359-87) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2023-12-28 |