| NPI | 1649212168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: TX 7885) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 11461) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2007-07-08 |