| NPI | 1639103682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: MN D9054) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D9054) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2024-07-17 |