| NPI | 1588425169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61488363) |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain (Licence: WA DE61488363) |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-01-19 |