| NPI | 1295898799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist Orofacial Pain (Licence: CO HD104952) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CO HD104952) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CO HD104952) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CO HD104952) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2023-10-06 |