| NPI | 1548263502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: TX 15227) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 15227) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX 15227) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2019-10-01 |