NPI | 1306822606 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: MA 15402) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 15402) |
Enumeration Date | 2005-12-19 |
Last Update Date | 2020-10-02 |