| NPI | 1336428929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: CA 104810) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 055710) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2022-01-11 |