| NPI | 1770588972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 10435) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 10435) |
| 1223X2210X Dentist, Orofacial Pain (Licence: MO 10435) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2021-10-05 |