| NPI | 1447383302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA 08390) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 08390) |
| 1223G0001X Dentist, General Practice (Licence: IA 08390) | |
| 1223X2210X Dentist, Orofacial Pain (Licence: IA 08390) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2021-11-01 |