| NPI | 1528061421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D7114) |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain (Licence: AZ D7114) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2020-09-05 |