| NPI | 1619985892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist Orofacial Pain (Licence: CA DDS49089) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 49089) |
| 1223G0001X Dentist General Practice (Licence: CA 49089) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA DDS49089) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2024-03-10 |