| NPI | 1710984695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist Orofacial Pain (Licence: GA DN123016) |
| Additional Taxonomies | 1223X2210X Dentist Orofacial Pain (Licence: AZ D008997) |
| 1223G0001X Dentist General Practice (Licence: NM DD1673) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-01-23 |