| NPI | 1568650877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D01872) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ d1872) |
| 1223X2210X Dentist, Orofacial Pain (Licence: AZ D01872) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ D01872) | |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2021-12-14 |