| NPI | 1295150571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist Orofacial Pain (Licence: MA DF11938) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DF11059) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2023-03-01 |