NPI | 1396443040 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: MN S196) |
Additional Taxonomies | 122300000X Dentist (Licence: MN s196) |
Enumeration Date | 2023-02-22 |
Last Update Date | 2024-11-04 |