| NPI | 1750408985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: OH 30016555) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30016555) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: OH 30016555) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2024-06-06 |