| NPI | 1730150525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN5112) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ME DEN5112) |
| 122300000X Dentist (Licence: TX 21674) | |
| 1223X2210X Dentist, Orofacial Pain (Licence: ME DEN5112) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2024-07-09 |