| NPI | 1326238023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: TX 35073) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 35073) |
| Enumeration Date | 2007-07-29 |
| Last Update Date | 2021-02-12 |