| NPI | 1316267735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 25399) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 25399) |
| 1223X2210X Dentist Orofacial Pain (Licence: TX 25399) | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2021-10-28 |