| NPI | 1689122988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: NY 000080) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 000080) |
| 1223X2210X Dentist, Orofacial Pain (Licence: NY 80) | |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2023-06-29 |