| NPI | 1346732153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: TX 34421) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 34421) |
| 122300000X Dentist (Licence: AZ 9990) | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2019-10-01 |