| NPI | 1669768156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 26525) |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain (Licence: TX 26525) |
| 122300000X Dentist (Licence: TX 26525) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2021-10-22 |