| NPI | 1417045931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: CA 40631) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 40631) |
| 122300000X Dentist (Licence: CA 40631) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2024-06-29 |