| NPI | 1497820963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: GA 11349) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 11349) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2025-04-16 |