| NPI | 1326733379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: VA 0401418565) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401418565) |
| Enumeration Date | 2023-04-06 |
| Last Update Date | 2026-04-15 |