| NPI | 1821135138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: CA 60877) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 60877) |
| 122300000X Dentist (Licence: CA 60877) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2025-10-16 |